NDC 904605161
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
00904-6051-61 - levETIRAcetam 250 mg Tab
Low
$0
Average
$6
Median
$1
High
$38
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Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 15 hospitals; the 90th percentile is 43.7× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Bluffton Health System LLC Bluffton, IN | $1 | $1 | — | — | — | $1 – $4 |
| 2 | Dukes Health System LLC Peru, IN | $2 | $2 | $0 | 18% | — | $1 – $7 |
| 3 | St. Joseph Health System, LLC Wayne, IN | $3 | $3 | — | — | — | $1 – $3 |
| 4 | Natchez Hospital Company LLC Natchez, MS | $39 | $34 | $14 | 40% | — | $2 – $46 |
| 5 | Northwest Sahurita Hospital LLC Tucson, AZ | $0 | $0 | $0 | 2% | — | $0 – $2 |
| 6 | Northwest Sahurita Hospital LLC Sahuarita, AZ | $0 | $0 | $0 | 2% | — | $0 – $2 |
| 7 | Oro Valley Hospital LLC Tucson, AZ | $0 | $1 | $0 | 30% | — | $0 – $2 |
| 8 | Northwest Hospital LLC Tucson, AZ | $0 | $1 | $0 | 31% | — | $0 – $2 |
| 9 | Metro Knoxville HMA LLC Powell, TN | $1 | $1 | — | — | — | $0 – $2 |
| 10 | Affinity Hospital LLC Birmingham, AL | $38 | $38 | $10 | 25% | — | $7 – $48 |
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